A curriculum for the times: an experiment in teaching health policy to residents in family medicine.

The Department of Family Medicine at Queen's University in Kingston, Ont., recently undertook a pilot project to familiarize residents in family medicine with physician-related health policy issues. The objective of the project was to ease the residents' transition into practice and to equip them to participate effectively in future policy debates. All first-year residents assigned to a 4-month clinical rotation in the Department of Family Medicine took part in the program, which consisted of 5 weekly 1-hour lecture and discussion sessions. The program was offered as one component of the 130-hour core curriculum for first-year residents. Participants evaluated the program as highly informative and extremely relevant to their career plans. The authors conclude that health policy is a subject that can be incorporated into the core curriculum of residency training programs.

Interactions with the pharmaceutical industry: a survey of family medicine residents in Ontario.

OBJECTIVE: To determine the attitudes, knowledge and practices of family medicine residents relating to the pharmaceutical industry and to assess the effectiveness of existing guidelines on appropriate interactions with the pharmaceutical industry. DESIGN: Survey by mailed questionnaire. SETTING: Ontario. PARTICIPANTS: All 262 second-year family medicine residents in Ontario (seven centres); 226 (86.3%) responded. RESULTS: Fifty-two (23.0%) of the residents who responded stated that they had read the CMA policy statement on appropriate interactions between physicians and the pharmaceutical industry. A total of 124 (54.9%) stated that they would attend a private dinner paid for by a pharmaceutical representative; the proportion was not significantly reduced among those who had read the CMA guidelines, which prohibit the acceptance of personal gifts. In all, 186 (82.3%) reported that they would like the opportunity to interact with pharmaceutical representatives in an educational setting, even though several programs now discourage these interactions. Approximately three quarters (172/226 [76.1%]) of the residents indicated that they plan to see pharmaceutical representatives in their future practice. Residents at Centre 2 were significantly more critical of the pharmaceutical industry than those from the other centres. Overall, being aware of, and familiar with, departmental policy or CMA policy on interactions with the pharmaceutical industry did not affect the residents' attitudes or intended future practices. CONCLUSION: The presence of guidelines concerning physicians' interactions with the pharmaceutical industry does not appear to have a significant impact on family medicine residents in Ontario.

Cervical spine abnormalities in institutionalized adults with Down's syndrome.

The prevalence of increased anterior atlanto-odontoid distance (AAOD), a risk factor for spinal cord compression, and degenerative disease of the cervical spine (DDCS) in a population of institutionalized adults with Down's syndrome (DS) was determined and compared with age- and sex-matched 'normals' presenting to a hospital emergency department. Radiographs of the cervical spines of 99 adults with DS and 198 'normals' were compared using a standardized rating scale. The prevalence of an AAOD of 3 mm or greater, the threshold of risk from the literature, was 8% for DS cases and 2% for controls (P < 0.01). The mean AAOD for DS cases was 2.0 +/- 1 mm and for controls 1.5 +/- 0.5 mm (P < 0.01). There was a negative correlation between AAOD and age of DS cases. The prevalence of any degree of DDCS among the DS cases was 64%, the controls 39% (P < 0.001); for moderate or severe DDCS the prevalence among DS cases was 45%, controls 12% (P < 0.001). The prevalence of DDCS increased with age in both groups, but the severity of DDCS was significantly increased with age in both groups, but the severity of DDCS was significantly greater for DS individuals in all age groups. The levels of the cervical spine affected ranged from C2 to C6; the most commonly affected level was C5-C6. While DS adults are at increased theoretical risk for spinal cord compression due to increased AAOD, its clinical significance would appear to be small and to decline with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Falls in the Elderly: Assessment and prevention in the community.

Falls are a significant cause of morbidity and mortality in the elderly. One in three older people will fall every year. Assessing intrinsic (patient) factors and extrinsic (environmental) factors that increase the risk of falling is an important part of caring for the elderly. Physicians can readily assess balance and mobility as part of a preventive approach.

A required program in geriatrics for medical students.

Very few medical schools in the United States have compulsory training in geriatrics for medical students. A program has been developed in the Department of Family Practice at Southern Illinois UniversitySchool of Medicine. This has become a required component of the undergraduate family practice clerkship. The initial format is described together with changes which occurred as result of student, faculty, and patient feedback, practical problems encountered in conducting the program, and changes in educational goals.

Geriatrics program for medical students and family practice residents. I. Establishing attitudes toward the aged.

This report concerns the initiation of required experience in geriatrics for undergraduate medical students and a program of research designed to evaluate that experience. Through the use of questionnaires, an attempt was made to differentiate between attitudes toward the elderly and their rehabilitation potential as stated by medical students, family practice residents, and professional and nonprofessional nursing-home staff members. Important differences were found between professional and nonprofessional groups, but no significant differences among professionals. Implications for the training of professional and nonprofessional staff members are discussed, and further research plans specified.